Title

Author

Date of Award

12-1993

Document Type

Dissertation

Degree Name

Master of Science (MS)

Program

Nursing

Research Advisor

Sylvia C. Price

Abstract

Each year pain disables approximately 50 million Americans. These patients seekhealth care for the relief of pain and its underlying cause. Many of those seeking relief from pain are hospitalized and others experience pain during their hospitalization. All of these patients have the right to relief of their pain and none should suffer pain needlessly. Yet, often nurses fail to accurately assess and adequately manage patients' pain.

Adequate pain management may increase patient perception of nursing care quality. The purpose of this study is to determine the relationships between pain relief and patients' and nurses' perceptions of quality. The relationship between the adequate treatment of pain and patients' perceptions of quality has not been examined. However, one study by Larrabee examined the relationship between severity of pain on exit interview and patient's perceptions of quality and found an inverse relationship.

This study was a secondary analysis of a study by Larrabee. The sample included a subset (N = 91) of the original 199 patients. This subset consisted of the patients who reported pain as their chief compliant, stated relief of pain as one of their three goals for hospitalization, and included the nursing diagnosis, "Alteration in Comfort, Pain; Actual" in the plan of care. This study tested the relationships among patient quality, value, and beneficence; and between patient quality, nurse quality, and nurse value; as proposed in Larrabee's model of quality.

There were three key findings. A positive relationship was demonstrat ed between patient-perceived quality and patient goal achievement Also, a positive relationship was demonstrated between both measures of patient value. Second, this study failed to demonstrate a relationship between patient-perceived quality and diminished pain. However, a positive relationship was demonstrated between patient goal achievement and diminished pain. Third, this study failed to demonstrate a relationship between patient-perceived quality and nurse-perceived quality.

The implications for nursing executives are 1) to further explore the relationship between patient goal achievement for pain and achievement of other goals, 2) to pursue avenues to increase mutual goal setting in order to increase patient-perceived quality, 3) to pursue avenues to effectively manage patients' pain because diminished pain is associated with higher patient goal achievement, which, in turn, is associated with higher patient-perceived quality, and 4) to further explore the relationship between patient-perceived quality and nurse-perceived quality. Such investigations should provide nursing executives with additional information that could guide quality improvement efforts.

In conclusion, nursing executives have humanitarian and economic incentives to improve pain management, mutual goal setting, development of pain management plan with patient and interdisciplinary collaboration, evaluation of pain management effectiveness, and to further investigate the relationships among patient quality, patient value, nurse quality, and nurse value, and pain. The humanitarian incentive is a pain free patient receiving quality care. Because patient satisfaction is directly related to patients intent to return, intent to recommend, and intent to sue, the economic incentive is market share